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I orgasm, and then I can't breathe

Dear Alice,

I'm a thirty-year-old woman. Recently I have started a terrible experience. When I am having sex, in the moment of my orgasm, my throat closes and I cannot breathe for a long time. Last time was scary because I spent more than 30 minutes with my throat completely closed and every one or two minutes I could take a big breath and again it closed. I felt like I was going to die; my partner gave me mouth-to-mouth respiration and I survived. I am really scared about having an orgasm again. It happened sometimes, but not so strongly as last night.

Do you know if this is some kind of disease or something? Asthma? What should I do?

Thanks for your help,
Lil

Dear Lil,

Some people do have asthma attacks during or after strenuous activity. This can sometimes be treated by using an inhaler prior to engaging in the activity.

It's hard to tell whether your experience is due to asthma (which happens when the breathing tubes become too narrow to allow the normal amount of oxygen into your system) or something else. It certainly sounds as if whatever is happening to you is enough to warrant a trip to your health care provider.

Exposure to substances to which you are allergic can also cause difficulty breathing. For example, was your partner wearing a latex condom? Allergies to latex are common. Allergic reactions become more severe with repeated exposure, so you might want to use a different type of condom, such as one made of polyurethane, or you can use the female condom, for a change (be aware that these condoms may have a slightly higher failure rate than do latex condoms). Visit your health care provider to be tested for a latex allergy, to get information on how to avoid exposure to latex (which is a component in lots of different products), and to learn how to treat a reaction, if you are truly sensitive or allergic.

Panic attacks, a chemical phenomenon in your body, can also cause difficulty breathing. They can occur for any number of reasons. It's not a "mind-over-matter" situation that you can easily control. It's a series of chemical events that cause symptoms. Sometimes a history of sexual trauma can be a factor in panic attacks associated with sex. Caffeine, alcohol and/or other drugs (including marijuana), and certain medications may also increase a person's likelihood of having a panic attack. Your health care provider can tell you about the variety of treatments available for panic attacks, including psychotherapy, behavioral techniques for lessening the effects of a panic attack, and medications that can prevent or limit them.

When did this start to happen? What is different? Perhaps you are holding your breath on the path to orgasm. Perhaps you don't want to orgasm for a while. Perhaps you have feelings about your partner, your life, and/or the sex you are having; feelings can have impact on sexual response.

If a health care provider rules out a medical cause for your orgasm-related symptoms, a sex therapist may be your next step, with the goal of getting back to enjoying sexual activities. In the meantime, don't strive for orgasm, just allow the pleasurable feelings to come in and be present. Pleasure, not orgasm, can be your sexual goal.